The Affordable Care Act in Action. Carla Haddad, MPH The Health Resources and Services Administration Office of Planning, Analysis and Evaluation

Transcription

1 The Affordable Care Act in Action Carla Haddad, MPH The Health Resources and Services Administration Office of Planning, Analysis and Evaluation

2 Percent of the Nonelderly Populations who are Eligible Uninsured Note: Eligible uninsured represents nonelderly (ages 0 to 64) uninsured legal residents. Source: ASPE tabulations of CY 2011 American Community Survey) PUMA data, adjusted to exclude undocumented persons based on imputation of immigrant legal status in ASPE s TRIM3 microsimulationmodel.

3 Two New Opportunities for Health Coverage 1. Medicaid States will have the opportunity to expand Medicaid coverage to individuals up to 133% FPL. 2. Private insurance purchased through the Health Insurance Marketplace. Some individuals will be eligible for subsidies to help with the costs of this insurance.

4 Medicaid Expansion States may expand Medicaid to non-elderly adults with incomes up to 133% of the Federal Poverty Level ($15,282/year for an individual, $31,322/year for a family of 4). One streamlined application for Medicaid or private health plans. Shifts to simplified way of calculating income to determine Medicaid/CHIP eligibility. States have no deadline to decide if they are going to expand.

5 Health Insurance Marketplace By October 1, 2013, every State will have a Marketplace where eligible individuals and small businesses can shop for and purchase private health insurance plans. Some Marketplaces will be operated by the Federal government, some by the State, and some via a Federal- State partnership. All citizens and lawfully present non-citizens (except the incarcerated) can purchase insurance through the Marketplace. A person cannot be denied due to health status

6 Marketplace Establishment Marketplace Establishment State-Based: 17 States & DC (royal blue) are setting up & managing their own Marketplaces. Partnership: 7 States (aqua blue) are working in partnership with the federal government. Federally-Facilitated: In 27 States (light blue) the federal government is setting up the Marketplace. Source: Kaiser Family Foundation. Status of State Health Insurance Exchange Decision, as of July 1, 2013,

7 3 Things to know about the Marketplace 1. It s an easier way to shop for health insurance Simplifies the search for health insurance All options are in one place One application, one time, and an individual or family can explore every qualified insurance plan in the area 2. Clear options with apples-to-apples comparisons All health insurance plans in the Marketplace present their price and benefit information in plain language 3. Most people will be able to get a break on costs 90% of people who are currently uninsured will qualify for discounted or free health insurance

8 Qualified Health Plans All Qualified Health Plans will cover these 10 Essential Health Benefits: 1. Ambulatory patient services 2. Emergency services 3. Hospitalization 4. Maternity and newborn care 5. Mental health and substance use disorder services, including behavioral health treatment 6. Prescription drugs 7. Rehabilitative and habilitative services and devices 8. Laboratory services 9. Preventive and wellness services and chronic disease management 10. Pediatric services, including oral and vision care

9 Eligibility Cheat Sheet Eligible : Income level % FPL For Medicaid? To purchase insurance through Marketplaces? For insurance purchased through the Marketplace: Premium Tax Credits Reduced costsharing 0 to 100% 100% - 133% Currently eligible people will generally remain eligible. Individuals with incomes up to 133% FPL will be able to enroll in Medicaid in states that implement Medicaid expansion Yes Yes No (Exception: legal immigrants) 133% - 250% Generally not (although some States cover some individuals) Yes Yes* 250% - 400% No Yes Yes* No Above 400% No Yes No No Not lawfully present No (except emergency Medicaid) No No No * unless eligible for other minimum essential coverage as defined in IRC 5000A(f)

10 How to Apply One streamlined application to apply for Medicaid, the Children s Health Insurance Program (CHIP), the new Health Insurance Marketplace, and tax credits that will help pay for premiums in the Marketplace Submit single, streamlined application to the Marketplace Verify and determine eligibility Eligible for Marketplace or Medicaid/CHIP Enroll (Marketplace) Online Phone Mail In Person Supported by Data Services Hub Enroll (Medicaid/CHIP)

11 Important Dates October 1, 2013 March 31, 2014: Initial open enrollment season for Health Insurance Marketplaces. Enrollment Date Effective Date of Coverage Oct. 1, 2013-Dec. 15, 2013 January 1, 2014 Dec. 16, 2013-Jan.15, 2014 February 1, 2014 Jan. 16, 2014-Feb. 15, 2014 March 1, 2014 Feb.16, 2014-Mar. 15, 2014 April 1, 2014 Mar. 16, 2014-Mar. 31, 2014 May 1, 2014 October 15, 20xx December 7, 20xx- Annual open enrollment season.

12 Where Consumers Can Get Help Healthcare.gov Toll-free Consumer Call Center - 24/ (150 languages) Website chat 24/7 (English and Spanish) In-Person Help (Assisters & Educators)

13 Consumer Assistance Framework Assisters Navigators Enrollment Assisters (FFM only) In-person Assisters (SPM only) Certified Application Counselors (hospitals, doctors offices, libraries, existing trusted business partners) Agents/Brokers Call Center Representatives Help consumers through the application, plan comparison, and enrolling in coverage and may be able to provide additional education about health insurance & program options In Find Local Help & Customer Service Referrals Find Local Help shows all organizations that have been trained & are available to help with application & enrollment. Trained state/local government employees will not be displayed. Application & Plan Compare Assistance See individuals personal information & data (PII) Help consumers fill out the application Help consumers compare plans & make an enrollment selection Provide education about the application and plan compare process Some may offer additional education about health insurance basics, program options, and plan offerings May conduct local outreach to bring consumers in the door for assistance Educators Provide basic awareness and education about the Marketplace and serve to refer people to customer service channels for assistance Partners & Stakeholders Local government branches & employees School administration & staff Are not displayed in Find Local Help & are not consumer referral points educators refer consumers Then Direct to Customer Service Website Call Center Assister Outreach about the Marketplace Create awareness of the Marketplace Drive consumers to Customer Service channels (website & assisters) Conduct outreach events & activities Provide basic information about the Marketplace and where to get help

14 A Call to Action Improve your health insurance literacy. Develop an outreach and education strategy tailored to the needs of your community. Engage with HRSA Regional Offices. Sign-Up for Updates. Join the Conversation on Twitter, Facebook, Tumblr, and YouTube.

15 Get the latest resources to help people apply, enroll, and get coverage in Marketplace.cms.gov

16 General Resources Consumer Websites: HealthCare.gov / CuidadoDeSalud.gov Consumer Call Center: Available 24/7 in 150 languages Partner/Stakeholder Website: Marketplace.cms.gov HRSA ACA Webpage: hrsa.gov/affordablecareact Social Media: Like HealthCare.gov / CuidadoDeSalud.gov on Facebook Follow HealthCare.gov / CuidadoDeSalud.gov on Twitter

17 Questions?